2010 Form 1120-L US Life Insurance Company Income Tax Return

Form 1120-L — U.S. Life Insurance Company Income Tax Return

For calendar year 2010 or tax year beginning , 2010, ending , 20___

Name:

Number, street, and room or suite no.:

City or town, state, and ZIP code:

A. Check if:

1 Consolidated return (attach Form 851)

2 Life-nonlife consolidated return

3 Schedule M-3 (Form 1120-L) attached

B. Employer identification number:

C. Date incorporated:

D. Check applicable box if an election has been made under section(s):

E. Check if: (1) Final return (2) Name change (3) Address change (4) Amended return

953(c)(3)(C): 953(d): Income

Income

1. Gross premiums, etc., less return premiums, etc. Enter balance:

2. Net decrease, if any, in reserves:

3. 10% of any decrease in reserves under section 807(f)(1)(B)(ii):

4. Investment income (Schedule B, line 8):

5. Net capital gain:

6. Income from a special loss discount account:

7. Other income:

8. Life insurance company gross income:

Deductions

9. Death benefits, etc.:

10. Net increase, if any, in reserves:

11. 10% of any increase in reserves under section 807(f)(1)(B)(i):

12. Deductible policyholder dividends:

13. Assumption by another person of liabilities under insurance contracts:

14. Dividends reimbursable by taxpayer:

15a. Interest: b. Less tax-exempt interest expense: c. Balance:

16. Deductible policy acquisition expenses:

17. Additional deduction:

18. Other deductions:

19. Add lines 9 through 18:

20. Subtotal:

21a. Dividends-received deduction: 21b. Operations loss deduction: 21c. Total:

22. Gain or (loss) from operations:

23. Small life insurance company deduction:

24. Life insurance company taxable income (LICTI):

25. Limitation on noninsurance losses:

26. Amount subtracted from policyholders surplus account:

27. Taxable income:

28. Total tax:

29a. 2009 overpayment credited to 2010 b. Prior year special estimated tax payments

29c. 2010 estimated tax payments d. 2010 special estimated tax payments

29e. Less 2010 refund applied for on Form 4466 f. Balance

29g. Tax deposited with Form 7004 h. Credits (Form 2439 / Form 4136)

29i. U.S. income tax paid or withheld at source j. Refundable credits k. Total

30. Estimated tax penalty Check if Form 2220 is attached

31. Amount owed

32. Overpayment

33. Credited to 2011 estimated tax Refunded

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Paid Preparer Use Only

Print/Type preparer’s name:

Preparer's signature:

Date:

Check if self-employed

PTIN:

Firm’s name:

Firm’s EIN:

Firm’s address:

Phone no.:

Schedule A — Dividend Income and Dividends-Received Deduction

1. Domestic corporations, less-than-20%-owned:

2. Domestic corporations, 20%-or-more-owned:

3. Debt-financed stock of domestic and foreign corporations:

4. Public utility corporations, less-than-20%-owned:

5. Public utility corporations, 20%-or-more-owned:

6. Foreign corporations, less-than-20%-owned, and certain FSCs:

7. Foreign corporations, 20%-or-more-owned, and certain FSCs:

8. Wholly owned foreign subsidiaries and certain FSCs:

9. Certain affiliated company dividends:

10. Gross dividends-received deduction:

11. Company share percentage:

12. Prorated amount:

13. Affiliated company dividends:

14. Other corporate dividends:

15. Total dividends:

16. Total deductions:

Schedule B — Gross Investment Income

1. Interest (excluding tax-exempt interest):

2. Gross taxable dividends:

3. Gross rents:

4. Gross royalties:

5. Leases, terminations, etc.:

6. Excess of net short-term capital gain over net long-term capital loss:

7. Gross income from trade or business other than an insurance business:

8. Investment income:

9. Tax-exempt interest:

10. Increase in policy cash value of section 264(f) policies:

11. Add lines 8, 9, and 10:

12. 100% qualifying dividends:

13. Gross investment income:

Additional schedules and pages continue in the PDF form.